Older Adults’ Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory

Abstract

Background Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory. Objective This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users. Methods The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed. Results In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants’ competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program. Conclusions In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix has been presented. Trial Registration ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849

Older adults as designers of behavior change strategies to increase physical activity—Report of a participatory design process

“…Therefore, the virtual coach was also created as an attempt to increase relatedness with the system. This expectation was confirmed in a qualitative evaluation of the behavior change support in the Safe step application (49). Experiences from a telecare intervention for older adults support the concept of relatedness with digital systems and suggest the utility of a broadened concept of relatedness beyond humanhuman interaction (50).…”

Reaching Older People With a Digital Fall Prevention Intervention in a Swedish Municipality Context—an Observational Study

“…Instructions for this were given in the videos and to be based on their own evaluations. The application includes “tools” to support behavior change in the form of an integrated calendar for planning and monitoring exercise activity ( 24 ). An integrated virtual physiotherapist provides reminders and feedback after each exercise session.…”

“…Safe Step is a fully self-managed digital exercise programme developed in co-creation with older people who were 70 years of age or older ( 23 ). A four-month feasibility study showed that participants who exercised with the Safe Step were more satisfied with the support than participants exercising with a self-managed booklet format ( 24 ). One year after the start of the intervention, participants who exercised with the digital programme were more likely to continue to exercise regularly (67%) than participants in the booklet group (35%) ( 25 ).…”

Does ICT Usage Have a Positive or Negative Effect on Taiwanese Older Adults’ Emotional Experiences? The Moderating Role of Basic Psychological Needs Satisfaction

“…Nevertheless, what is known from past research is that basic psychological needs satisfaction may moderate the relationship between ICT use and emotion ( Allen and Anderson 2018 ; Przybylski et al 2009 ; Fang et al 2019 ; James et al 2022 ; Partala and Kallinen 2012 ; Pettersson et al 2021 ). For example, Przybylski et al ( 2009 ) found that when people’s basic psychological needs are satisfied, they will have a better experience when playing games on ICT; however, when their satisfaction with basic psychological needs is low, they will experience negative emotions such as stress when playing games with ICT.…”

“…Current research states that autonomy needs satisfaction may moderate the association between ICT use and emotional experience for older adults. Pettersson et al ’s ( 2021 ) study using an exercise app as a research tool found that when older adults’ autonomy needs were satisfied, they felt that it was very meaningful to use the app. Conversely, when older adults’ autonomy needs were not met, they experienced negative emotions such as anxiety when using ICT ( Di Giacomo et al 2019 ).…”